Minimally invasive surgical approaches to thoracic sympathectomy for hyperhidrosis

Abstract

Thoracic sympathectomy is used for the palliation of hyperhidrosis. However, significant controversies surround the optimal surgical approach and the extent of sympathectomy. The determinants of success in the surgical palliation of hyperhidrosis are the postoperative rate of anhidrosis, recurrence of symptoms, and rate of compensatory hyperhidrosis. This paper attempts to shed light on the controversies by examining the historic background, clearly defining the anatomic considerations, and outlining the various surgical approaches culminating with robotic selective dorsal thoracic sympathectomy.

Keywords

Sympathectomy / hyperhidrosis / robotic / minimally invasive / thoracoscopic / selective sympathectomy

References

[1] Royle JP.History of sympathectomy..Aust N Z J Surg1999;69:107-12

[2] Brown WL.The Involuntary Nervous System.1916;LondonLongman, Green and Co.

[3] Bernard C.Sur les effets de la section de la portion cephalous du grand sympathique..Comptes rend Soc Biol1852;4:168-70

[4] Brown-Sequard CE.Experimental researches applied to physiology and pathology..M Exam1852;8:481548,617,698 PMCID:PMC6347624

[5] Alexander W.The treatment of epilepsy.1889;EdinburghCambridge University Press228

[6] Jonnesco T.Resecta totala si bilaterala a simpaticulu cervical in cazuri de epilepsie si gusa exophthalmia..Romania Med1896;4:479-96

[7] Jaboulay M.Le traitement de quelques troubles trophiques du pied et de la jambe par la dénudation de l’artère fémorale et la distension des nerfs vasculaires..Lyon Med1899;91:467-8

[8] Francois-Frank M.Signification ohysiologique de la resection du sympathique dans la maladie de Basedow, l’epilepsie, l’idiotie etle glaucoma..Bull Acad Med Paris1899;41:565-94

[9] Jonnesco T.Angine de poi trine guerie par le resection du sympathique cervicothoracique..Bull Acad Med Paris1920;84:93-102

[10] Leriche R.De elongation et de la section des nerfs perivasculaires dans certain syndrome douloureux d’origine arterielle et dans quelque troubles trophique..Lyon Chir1913;10:378-82

[11] Bruning F.Zur technik der kombinierten resectionsmethode samtlicher sympathischen nervenbahnen am hasle..Zentralbl Chir1923;5:1056-9

[12] Kotzareff A.Resection partielle du tronc sympathique cervical droit pour hyperhidrose unilaterale..Rev Med Suisse Rom1920;40:111-3

[13] Royle ND.A new operative procedure in the treatment of spastic paralysis and its experimental basis..Med J Aust1924;1:77-86

[14] Diez J.Un Nuevo methdo de simpatectomia periferica para el tratamiento de las afecciones troficas y gangrenosas de los miembros..Bol Soc Cir Buenos Aires1924;8:792-806

[15] Adson AW.treatment of Raynaud’s disease by lumbar ram section and ganglionectomy’s and per vascular sympathetique neurectomy of the common iliacs.JAMA1925;84:1908-10

[16] Hughes J.Endothoracic sympathectomy..Proc Roy Soc Med1942;35:585-6 PMCID:PMC1998305

[17] Kux M.Thoracic endoscopes sympathectomy in palmar and axillary hyperhydrosis..Arch Surg1978;113:264-6

[18] Wittmoser R.Cuschieri A.Toracoscopic Sympathectomy and agronomy. In Operative manual of endoscopes Surgery.1992;BerlinSringer Verlag

[19] Schurr MO.Wittmoser’s technique of thoracoscopic sympathectomy and agronomy..Endosc Surg1993;1:266-70

[20] Friedel G,Toomes H.Mannke K.Sympathectomy and agronomy. In: Minimal Access Thoracic Surgery.1998;LondonChapman Hall67-83

[21] Kuntz A.Distribution of the sympathetic rami to the brachial plexus. Its relation to sympathectomy affecting the upper extremity..Arch Surg1927;15:871-7

[22] Carron H.Stellate ganglion block..Anesth Analges1975;54:567-70

[23] Pather S,Sengh B.Cervico-thoracic ganglion: its clinical implications..Clin Anat2006;19:323-6

[24] Hashmonai M,Licht PB,Schick CH.Thoracic sympathectomy: a review of current indications..Surg Endosc2016;30:1255-69

[25] Drucker WR,Holden WD.Pathogenesis of post-traumatic sympathetic dystrophy..Am J Surg1959;97:454-65

[26] Friedel G,Toomes H.Selective video-assisted thoracoscopic sympathectomy..Thorac Cardiovasc Surg1993;41:245-8

[27] Hazelrigg SR.Kaiser LR.Surgery for autonomic disorders. Thoracoscopic Surgery..1993;BostonLittle, Brown and Company189-202

[28] Lakraj AD,Jabbari B.Hyperhidrosis: anatomy, pathophysiology and treatment with emphasis on the role of botulinum toxins..Toxins2013;5:821-40 PMCID:PMC3705293

[29] Bajaj V.Use of oral glycopyrronium bromide in hyperhidrosis..Br J Dermatol2007;157:118-21

[30] Gish P,Truffa M.Spectrum of central anticholinergic adverse effects associated with oxybutynin: comparison of pediatric and adult cases..J Pediatr2009;155:432-4

[31] Schneier RF.Social anxiety disorder..New Engl J Med2006;355:2702

[32] Solish N,Dansereau A,Lynde C.A Comprehensive approach to the recognition, diagnosis, and severity-based treatment of focal hyperhidrosis: recommendations of the canadian hyperhidrosis advisory committee..Dermatologic Surgery2007;33:908-23

[33] Levitt F.Treatment of hyperhydrosis by tap water iontopheresis..Cutis1980;26:192

[34] Weinberg T,Murray C.Botulinum neurotoxin treatment of palmar and plantar hyperhidrosis..Dermatol Clin2014;32:505-15

[35] Lowe NJ,Eadie N,Kowalski JW.Botulinum toxin type A in the treatment of primary axillary hyperhidrosis: a 52-week multicenter double-blind, randomized, placebo-controlled study of efficacy and safety..J Am Acad Dermatol2007;56:604-11

[36] Jacob C.Treatment of hyperhidrosis with microwave technology..Semin Cutan Med Surg2013;32:2-8

[37] Hong HC,O’Shaughnessy KF.Clinical evaluation of a microwave device for treating axillary hyperhidrosis..Dermatol Surg2012;38:728-35 PMCID:PMC3489040

[38] Fatemi Naeini F,Pourazizi M,Mirmohammadkhani M.Fractionated microneedle radiofrequency for treatment of primary axillary hyperhidrosis: a sham control study..Australas J Dermatol2015;56:279-84

[39] Abtahi-Naeini B,Saffaei A,Pourazizi M.Treatment of primary axillary hyperhidrosis by fractional microneedle radiofrequency: is it still effective after long-term follow-up?.Indian J Dermatol2016;61:234 PMCID:PMC4817464

[40] Glaser DA.Local procedural approaches for axillary hyperhidrosis..Dermatol Clin2014;32:533-40

[41] Lawrence CM.Selective sweat gland removal with minimal skin excision in the treatment of axillary hyperhidrosis: a retrospective clinical and histological review of 15 patients..Br J Dermatol2006;155:115-8

[42] Dondelinger RF.Percutaneous phenol block of the upper thoracic sympathetic chain with computed tomography guidance. A new technique..Acta radiol1987;28:511-5

[43] Adler O,Sargeno D.Palmar hyperhidrosis treated by percutaneous transthoracic chemical sympathicolysis..Eur Radiol1994;4:57-62

[44] Wilkinson HA.Radiofrequency percutaneous upper thoracic sympathectomy. Technique and review of indications..N Engl J Med1984;311:34-8

[45] Wilkinson HA.Percutaneous radio frequency upper thoracic sympathectomy..Neurosurgery1996;38:715-25

[46] Telford ED.The technique of sympathectomy..Br J Surg1935;23:448-50

[47] Atkins H.Sympathectomy by axillary approach..Lancet1954;1:538

[48] Raposio E.Video-assisted thoracic Sympathicotomy for the treatment of palmar and Axillary Hyperhidrosis. A 17-year Experience..Surg Laparosc Endosc Percutan Tech2015;25:417-9

[49] Raposio E,Grieco MP.Minimally Invasive dorsal sympathicotomies for the treatment of hyperhidrosis: palmar microcirculatory assessment as an intraoperative aid..Eur J Plast Surg2018;41:4417-50

[50] Teleranta T.Secondary sympathetic chain reconstruction after endoscopes thoracic sympathectomy..Eur J Surg1998;1:1-8

[51] Hashmonai M,Kopelman D.Thoracoccopic sympathectomy for palmar hyperhydrosis. Ablate or resect?.Surg Endosc2001;15:435-41

[52] Cerfolio RJ,Bryant AS,Miller DL.The Society of thoracic surgeons expert consensus for the surgical treatment of hyperhidrosis..Ann Thorac Surg2011;91:1642-8

[53] Riet M,Kuiken H,Bonjer HJ.Prevention of compensatory hyperhidrosis after thoracoscopic sympathectomy for hyperhidrosis..Surg Endosc2001;15:1159-62

[54] Neumayer C,Holak G,Jakesz R.Limited endoscopic thoracic sympathetic block for hyperhidrosis of the upper limb: reduction of compensatory sweating by clipping T4..Surg Endosc2004;18:152-6

[55] Lin TS.Endoscopic clipping in video-assisted sympathetic blocade for axillary hyperhydrosis. An analysis of 26 cases..Surg Endosc2001;15:126-8

[56] Lin CC.Lin-Telaranta classification: the importance of different procedures for different indications in sympathetic surgery..Ann Chir Gynaecol2001;90:161-6

[57] Schmidt J,Altmeyer P.Endoscopic thoracic sympathectomy for severe hyperhidrosis: impact of restrictive denervation on compensatory sweating..Ann Thorac Surg2006;81:1048-55

[58] Gossot D,Fritsch S.Thoracoscopic sympathectomy for upper limb hyperhidrosis: looking for the right operation..Ann Thorac Surgery1997;64:975-8

[59] Doolabh N,Williams M,Prince S.Thoracoscopic sympathectomy for hyperhidrosis: indications and results..Ann Thorac Surg2004;77:410-4discussion 414

[60] Licht PB.Gustatory side effects after thoracoscopic sympathectomy..Ann Thorac surg2006;81:1043-7

[61] Licht PB,Ladegaard L.Thoracoscopic sympathectomy for axillary hyperhydrsis: The influence of T4..Ann Thorac Surg2005;80:455-60

[62] Kwong KF,Bennett LA,Gamliel Z.Clinical experience in 397 consecutive thoracoscopic sympathectomies..Ann Thorac Surg2005;80:1063-6discussion 1066

[63] Baumgartner FJ.Severe hyperhydrosis: clinical features and current thoracoscopic surgical management..Ann Thorac surg2003;76:1878-83

[64] Lee DY,Paik HC.Selective division of T3 rami communicantes (T3 craniotomy) in the treatment of palmar hyperhydrosis..Ann thoarac Surg2004;78:1052-5

[65] Furlan AD,Papagapiou M.Are we paying a high price for surgical mpathectomy? A systematic literature review of late complications..J Pain2000;1:245-57

[66] Lin TS,Huang LC.Pitfalls and complication avoidance associated with transthoracic endoscopes sympathectomy for primary hyperhidrosis (analysis of 2200 cases)..Int J Surg Invest2001;2:377-85

[67] Lee DY,Paik HC.Selective division of T3 rami comunicantes (T3 ramicotorny) in the treatment of palmar hyperhidrosis..Ann Thorac Surg2004;78:1052-5

[68] Coveliers H,Gharagozloo F,Rauwerda J.Robotic selective postganglionic thoracic sympathectomy for the treatment of hyperhidrosis..Ann Thorac Surg2013;95:269-74

[69] Coveliers H,Gharagozloo F.Selective sympathectomy for hyperhidrosis: technique of robotic transthoracic selective postganglionic efferent sympathectomy..Eur J Cardiothorac Surg2013;43:428-30

[70] Gharagozloo F.Robotic selective thoracic sympathectomy for hyperhidrosis..Mini-invasive Surg2020;4:14

[71] Gharagozloo F.Pain management following robotic thoracic surgery..Mini-invasive Surg2020;4:8

[72] Nishimura JM,Kneuertz P,Merritt RE.Robotic lobectomy costs and quqlity of life..Mini-inavsive Surg2020;4:11

[73] Kneuertz PJ,D’Souza DM,Moffatt-Bruce SD.Hospital cost and clinical effectiveness of robotic-assisted versus video-assisted thoracoscopic and open lobectomy: a propensity score-weighted comparison..J Thorac Cardiovasc Surg2019;157:2018-26